Monday 6 March 2017

Major research project by Save the Children finds widespread evidence of 'toxic stress' and mental health issues among children inside Syria, as experts warn the psychological damage could be irreversible


Saeed*, three, inside an abandoned petrol station where he and his family now live. The petrol station, badly damaged by war, is now the home of five families who have returned to Tel Abiad district, Raqqa Governorate, Syria, after fleeing from ISIS two years earlier only to find their homes destroyed. Save the ChildrenSaeed*, three, inside an abandoned petrol station where he and his family now live. The petrol station, badly damaged by war, is now the home of five families who have returned to Tel Abiad district, Raqqa Governorate, Syria, after fleeing from ISIS two years earlier only to find their homes destroyed. Save the Children


New multimedia content on child mental health available at these links, including photos and case studies from inside Syriab-roll and interviews from inside Syria and b-roll, case studies and photos with refugee families in Jordan.

  • Findings show 84% of adults and almost all children believe ongoing bombing and shelling is the number one cause of psychological stress in children’s daily lives
  • 50% of children say they never or rarely feel safe at school and 40% say they don’t feel safe to play outside, even right outside their own home.
  • 89% of adults said children’s behaviour has become more fearful and nervous as the war goes on
  • 71% said that children increasingly suffer from frequent bedwetting and involuntary urination
  • Experts say we are reaching a crisis point; if the war does not end soon and children don’t receive the psychological support they need, it will be much harder to repair the damage when they reach adulthood.

A new report by Save the Children has revealed a mental health crisis among children trapped in Syria, as the war approaches the six year mark.

The charity and its Syrian partners interviewed more than 450 children, adolescents and adults across seven governorates in Syria for “Invisible Wounds”, the largest study of its kind conducted during the course of the conflict. It found that many children are living in an almost constant state of fear, terrified by shelling, airstrikes and ongoing violence, with devastating psychological consequences.

Mental health experts consulted for this report said it showed children are suffering from a condition called ‘toxic stress’, which can occur when children experience strong, frequent or prolonged adversity¸ such as the extreme violence occurring in the Syria conflict. [1] Continuous toxic stress response can have a life-long impact on children’s mental and physical health.

The research revealed how the war has ruined childhoods. Almost half of children interviewed said they did not feel safe at school or playing outside. In interviews and focus groups, it was found that 78% of children feel grief and extreme sadness some or all of the time and almost all adults said children had become more nervous or fearful as the war has gone on.

Zeinab, aged 12, at a displaced persons camp in Hassakeh NE Syria: “When the war came, all the Syrian children forgot everything they learned and now know nothing else except war. I feel like I’ve seen so many terrible things. I lost out on two years of school, and my brother has grown up and has hardly studied at all. What if I get old and I continue on this same path and I lose out on my entire future?”

The constant psychological strain on children has manifested itself in bed wetting, involuntarily urination in public, speech impediments and children losing the ability to speak altogether, increased aggression and substance abuse.  Communities and professionals also report a rise in self harm and suicide attempts among children as young as 12.

Mohammed, aid worker with Save the Children partner Shafak in Idlib: “I’m speaking to you from an area where people could die at any moment, and this lack of safety and security is leading to a lot of psychological problems in children. We notice that they are always stressed and react to any unfamiliar noise, if a chair moves or the door bangs, because of their fear of the sound of airplanes and rockets. Children are increasingly isolated and don’t like to participate in our activities, and in the young children we’re seeing a lot of cases of involuntary urination.”

Symptoms like this can be a sign of “toxic stress” in children, described by experts as the most dangerous form of stress response a child can experience.

Alexandra Chen, Child Protection and Mental Health Specialist based at Harvard University: “While children are resilient, the repeated exposure to extreme traumatic events many Syrian children experience puts them at a significant risk of living in a state of toxic stress.”

“This is likely to have a life-long and devastating impact on these children’s mental and physical health, disrupting the development of the brain and other organs and increasing the risk of heart disease, substance abuse, depression and other mental health disorders into adulthood.”

With an end to the violence, the right support and early interventions, children can recover from traumatic experiences. However, the child mental health crisis is reaching a tipping point in Syria just as family support structures and official services are collapsing.

With adults themselves highly stressed and struggling to cope, one in four children interviewed said that they rarely or never have a place to go or someone to talk to when they are scared, sad or upset.

Many doctors and professionals have fled the country, and the relentless bombing and blocks on aid workers reaching the worst hit areas means there is little official provision for mental health services. Where they exist, social stigma often prevents people accessing them.

Dr Marcia Brophy, Save the Children Senior Mental Health and Psychosocial Support Adviser for the Middle East:  “We are failing children inside Syria, some of whom are being left to cope with harrowing experiences, from witnessing their parents killed in front of them to the horrors of life under siege, without proper support. We risk condemning a generation of children to a lifetime of mental and physical health problems – we need to ensure that children who have already lost six years of their lives to war don’t have to lose their whole future as well.”

Ultimately, the only way to begin undoing the damage done to children is to stop the root cause of their distress – the ongoing violence in Syria, particularly airstrikes and shelling which came out strongly in the report as the primary cause of child mental health issues.

Helle Thorning-Schmidt, Save the Children International CEO, said:

“What this research shows is that we are witnessing a mental health crisis among Syrian children, brought about by six years of war.

“Some Syrian children have grown up knowing nothing but war. As well as the physical harm endured by children, the psychological consequences are devastating. We have heard of children wetting the bed, losing the ability to speak and experiencing ‘toxic stress’, which psychologists deem the most dangerous form of stress a child can experience.”

“It is a tragedy that can’t be allowed to continue – and we can end the suffering of these children; by stopping the bombardment of civilian areas and reaching everyone with life-saving aid and psychological support.”

In addition to an immediate ceasefire and a negotiated end to the violence, Save the Children is calling for:

  • All parties to stop using explosive weapons in populated areas and attacking civilian infrastructure like schools and hospitals, as this clearly came through as the main cause of children’s distress and fear.
  • An immediate end to siege tactics and unrestricted humanitarian access to all areas, so that agencies like Save the Children and our partners can reach the most vulnerable.
  • Donors to make a new global commitment to support children’s mental health and wellbeing in emergencies, including sufficient funding for mental health and psychosocial programming inside Syria

Notes to editors

  • For this report, Save the Children staff and partners spoke to 458 children, adolescents and adults inside seven of Syria’s 14 governorates – the largest and most comprehensive study undertaken into children’s mental health and wellbeing inside Syria during the conflict.
  • The research took place between December 2016 and February 2017 and consisted of: 
    - 313 individual questionnaires,[i] including 154 adolescents aged 13–17 (59 girls, 95 boys) and 159 parents and adult caregivers (61 women, 98 men).
    - 17 focus groups with 125 children (56 girls, 69 boys) split into four age groups: 5-7, 8-11, 12-14 and 15-17 years. The older ages were divided into groups of girls and boys.
    - In-depth interviews with 20 psychosocial workers, children, aid workers, teachers, parents and psychologists.

    The research was carried out with trained practitioners who also offered psychosocial first aid to children involved. It took place in multiple locations in Aleppo, Damascus, Dara’a, al-Hasakah, Homs, Idlib, and Rif Damascus, with additional interviews with experts based in countries neighbouring Syria.

  • Save the Children would like to thank our dedicated Syria staff as well as the many Syrian communities, individuals and humanitarian organisations that contributed to this report. These include: Violet, Shafak, Olive Branch, Syria Relief, the Syrian American Medical Society (SAMS) and numerous others who wish to remain anonymous in order to continue their efforts to help children in Syria.
  • Save the Children provides mental health and psychosocial support (MHPSS) and education activities for children across 10 governorates of Syria, as well as in countries hosting Syrian refugees. Our approach to MHPSS programming includes HEART (Healing and Education through the Arts for children) and Child Resilience, and follows the Inter-Agency Standing Committee guidelines on mental health and psychosocial programming.

    In addition, Save the Children supports seven primary healthcare facilities and a maternity hospital, conducts vaccination campaigns and distributes household items, hygiene kits and winter kits, among other activities in Syria. To date our programmes have reached more than 2.4 million people inside Syria, including over 1.5 million children.